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Preparing for Surgery
Once you've decided to have bariatric surgery, an expert will guide you on the preparation for surgery. Testing, clearances and insurance all play a role. Julie Mulch, Surgical Coordinator, discusses how to prepare for bariatric surgery.
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Learn more about Julie Mulch
Julie Mulch
Julie Mulch is the Surgical Coordinator, Toms River Garden State Bariatrics & Wellness Center.Learn more about Julie Mulch
Transcription:
Bill Klaproth (Host): Leading up to your surgery, there are several details that need to be taken care of. And here to talk with us about preparation before surgery is Julie Mulch, Surgical Coordinator at Garden State Bariatrics and Wellness Center. Julie thank you for your time. We appreciate it. So, once a patient has decided to go ahead with bariatric weight loss surgery, all the patients will then coordinate with you beforehand. Is that right?
Julie Mulch (Guest): That is correct.
Host: So, when does that hand off take place? When do you contact them once they have decided on the surgery? Do you reach out to them? Are they given your contact information? How does that work?
Julie: Once they have decided to come in for the visit, they will see the doctor. After seeing the doctor and discussing what procedure they would like to have and their health history and family history all that takes into consideration what testing they would need to have done and what clearances they would need to have done. And the doctor brings the patient in to me after their initial eval and then we sit down and go over all the testing and the doctors that they would have to see in order to get the clearances to have the surgery. And also, we will go over the steps that are needed in order to get approval from the insurance company. Each insurance company is slightly different.
Host: Alright, so, let’s take each one of those by itself. First of all, appointments. So further appointments down the road, you take care of those with the patient as well?
Julie: Some of them we do in-house here. Our nutrition visits are done here at Garden State Bariatrics and I get the patient set up for their nutritional evaluations here with our nutritionist. Some of the visits are done with their own doctors on the outside and for those visits, I tell the patient what they need to have done and in what timeframe and then they make the appointments themselves to see those doctors. So, it’s a mix of stuff done here in-house as well as outside doctors that the patient is already established with.
Host: And when it comes to the actual surgery date, do you make that appointment with the patient? Are you involved in that?
Julie: I do. I do. I try to, based on the doctor’s schedule, I try to let the patient pick the day they would like and if we can work on that and get that date set for them, that’s what we will do but I am the one that will help them to pick the date of surgery.
Host: And you previously mentioned nutrition. I know you are not a nutritionist but just so the listener knows. What do you do with them as far as nutrition evaluation before surgery?
Julie: All of the insurance companies require a certain amount of nutritional visits, depending on which insurance it is, that’s how we know how many are necessary. We always have our patients do at least three visits and our visits like I said are done here with our dietician at Garden State Bariatrics. You do need to see the nutritionist one time a month for anywhere from three months to six months depending on your insurance. Usually, it’s three months.
Host: Alright and speaking of insurance then, a lot of people I’m sure have questions about insurance, what it covers, how it works, prior authorization. Can you kind of give us the overview of insurance and how you work with patients?
Julie: Yes. Again, each insurance requires a different set of criteria in order to approve the surgeries. Once you come in and I know exactly what insurance you have; I will research exactly what your insurance entails. Usually, it’s the nutritional visits. It’s a psychological evaluation. I have a psychologist that we can refer to, it’s usually one time, one visit. They just want to make sure that you can – you have the metal capacity to make that decision and some of them require some additional information, some proof of weightloss attempts in the past. Some of them, they don’t really require that, but the main thing is you have to have the psychological evaluation and the nutritional visits, and we send that, and you have to have a 35 BMI with a comorbidity which is any kind of a health issue. High blood pressure, diabetes, sleep apnea. If you don’t have any of those health issues, then your BMI which is your body mass index would have to be at a 40 or greater to qualify for the insurance companies.
Host: So, all of this is part of the medical testing that goes on before surgery. Is that correct?
Julie: That’s correct.
Host: And is there anything else as far as medical testing goes that we should know about?
Julie: They are required to get an endoscopy which is a simple test. They go look at the stomach, take a biopsy, make sure everything is okay. Our doctor, Dr. Yurcisin, he does perform them or if you like, you can go to – if you have your own GI doctor already, you can certainly have that done with them. But that is another test that needs to be done in order to have the procedure done. The insurance company doesn’t require that, but the doctor does.
Host: Now I know before surgery, you also work with patients on the facilities. Is that go here, go there, you will find this here? Is that what that means?
Julie: Yes. We – our doctors at this moment are working at three different hospitals. They do their surgery out of Monmouth Medical in Long Branch. They do it at St. Barnabas Medical Center in Livingston and at Deborah Heart and Lung in Browns Mills. So, usually it’s done at the patient’s convenience which is closest to them or if they have a preference. Otherwise, it can just fall on whichever date they like. If the doctor is at this hospital or that hospital and they want that particular date, even if you come to the Tom’s River office, we can still book for any of those three facilities.
Host: Julie I could see where clear communication is very important to make sure people know where to go and when. And is there any other aspects or requirements to complete prior to surgery?
Julie: That is about it. It sounds like a lot, but and it sounds like it could take quite a bit of time but as the patients come in, right before their surgery they say wow, that really went fast. So, it sounds like a lot, but I’m here to guide you and help you and make sure that everything gets done in the right timeframe. Some of the stuff has to wait until 30 days before surgery. Some of it can get done in the beginning. So, I’m here to help you and walk you through it and guide you through it. And it’s a pretty simple process. We will do all the work on our end, you just have to show up for the appointments.
Host: Well Julie thank you. This has been very informative and for patients who are scheduled for surgery, I know this podcast will help them out and certainly being able to hear you and understand what’s going to happen prior to surgery is very valuable. So, thank you again for your time. For more information please visit the Garden State Bariatrics and Wellness Center website at www.gsbwc.com, that’s www.gsbwc.com. This is Winning Through Losing, a Weightloss Surgery Podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.
Bill Klaproth (Host): Leading up to your surgery, there are several details that need to be taken care of. And here to talk with us about preparation before surgery is Julie Mulch, Surgical Coordinator at Garden State Bariatrics and Wellness Center. Julie thank you for your time. We appreciate it. So, once a patient has decided to go ahead with bariatric weight loss surgery, all the patients will then coordinate with you beforehand. Is that right?
Julie Mulch (Guest): That is correct.
Host: So, when does that hand off take place? When do you contact them once they have decided on the surgery? Do you reach out to them? Are they given your contact information? How does that work?
Julie: Once they have decided to come in for the visit, they will see the doctor. After seeing the doctor and discussing what procedure they would like to have and their health history and family history all that takes into consideration what testing they would need to have done and what clearances they would need to have done. And the doctor brings the patient in to me after their initial eval and then we sit down and go over all the testing and the doctors that they would have to see in order to get the clearances to have the surgery. And also, we will go over the steps that are needed in order to get approval from the insurance company. Each insurance company is slightly different.
Host: Alright, so, let’s take each one of those by itself. First of all, appointments. So further appointments down the road, you take care of those with the patient as well?
Julie: Some of them we do in-house here. Our nutrition visits are done here at Garden State Bariatrics and I get the patient set up for their nutritional evaluations here with our nutritionist. Some of the visits are done with their own doctors on the outside and for those visits, I tell the patient what they need to have done and in what timeframe and then they make the appointments themselves to see those doctors. So, it’s a mix of stuff done here in-house as well as outside doctors that the patient is already established with.
Host: And when it comes to the actual surgery date, do you make that appointment with the patient? Are you involved in that?
Julie: I do. I do. I try to, based on the doctor’s schedule, I try to let the patient pick the day they would like and if we can work on that and get that date set for them, that’s what we will do but I am the one that will help them to pick the date of surgery.
Host: And you previously mentioned nutrition. I know you are not a nutritionist but just so the listener knows. What do you do with them as far as nutrition evaluation before surgery?
Julie: All of the insurance companies require a certain amount of nutritional visits, depending on which insurance it is, that’s how we know how many are necessary. We always have our patients do at least three visits and our visits like I said are done here with our dietician at Garden State Bariatrics. You do need to see the nutritionist one time a month for anywhere from three months to six months depending on your insurance. Usually, it’s three months.
Host: Alright and speaking of insurance then, a lot of people I’m sure have questions about insurance, what it covers, how it works, prior authorization. Can you kind of give us the overview of insurance and how you work with patients?
Julie: Yes. Again, each insurance requires a different set of criteria in order to approve the surgeries. Once you come in and I know exactly what insurance you have; I will research exactly what your insurance entails. Usually, it’s the nutritional visits. It’s a psychological evaluation. I have a psychologist that we can refer to, it’s usually one time, one visit. They just want to make sure that you can – you have the metal capacity to make that decision and some of them require some additional information, some proof of weightloss attempts in the past. Some of them, they don’t really require that, but the main thing is you have to have the psychological evaluation and the nutritional visits, and we send that, and you have to have a 35 BMI with a comorbidity which is any kind of a health issue. High blood pressure, diabetes, sleep apnea. If you don’t have any of those health issues, then your BMI which is your body mass index would have to be at a 40 or greater to qualify for the insurance companies.
Host: So, all of this is part of the medical testing that goes on before surgery. Is that correct?
Julie: That’s correct.
Host: And is there anything else as far as medical testing goes that we should know about?
Julie: They are required to get an endoscopy which is a simple test. They go look at the stomach, take a biopsy, make sure everything is okay. Our doctor, Dr. Yurcisin, he does perform them or if you like, you can go to – if you have your own GI doctor already, you can certainly have that done with them. But that is another test that needs to be done in order to have the procedure done. The insurance company doesn’t require that, but the doctor does.
Host: Now I know before surgery, you also work with patients on the facilities. Is that go here, go there, you will find this here? Is that what that means?
Julie: Yes. We – our doctors at this moment are working at three different hospitals. They do their surgery out of Monmouth Medical in Long Branch. They do it at St. Barnabas Medical Center in Livingston and at Deborah Heart and Lung in Browns Mills. So, usually it’s done at the patient’s convenience which is closest to them or if they have a preference. Otherwise, it can just fall on whichever date they like. If the doctor is at this hospital or that hospital and they want that particular date, even if you come to the Tom’s River office, we can still book for any of those three facilities.
Host: Julie I could see where clear communication is very important to make sure people know where to go and when. And is there any other aspects or requirements to complete prior to surgery?
Julie: That is about it. It sounds like a lot, but and it sounds like it could take quite a bit of time but as the patients come in, right before their surgery they say wow, that really went fast. So, it sounds like a lot, but I’m here to guide you and help you and make sure that everything gets done in the right timeframe. Some of the stuff has to wait until 30 days before surgery. Some of it can get done in the beginning. So, I’m here to help you and walk you through it and guide you through it. And it’s a pretty simple process. We will do all the work on our end, you just have to show up for the appointments.
Host: Well Julie thank you. This has been very informative and for patients who are scheduled for surgery, I know this podcast will help them out and certainly being able to hear you and understand what’s going to happen prior to surgery is very valuable. So, thank you again for your time. For more information please visit the Garden State Bariatrics and Wellness Center website at www.gsbwc.com, that’s www.gsbwc.com. This is Winning Through Losing, a Weightloss Surgery Podcast with Garden State Bariatrics. I’m Bill Klaproth. Thanks for listening.